Psychological and Social Aspects of Hearing Loss

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1 Psychological and Social Aspects of Hearing Loss

2 Adjusting to your Child s Diagnosis of Hearing Loss When you learn your child has a hearing loss you may feel grief, shock, worry, anger, or sadness. It may feel that some of the dreams you had for your child have been taken away from you. This time can be stressful and marked with doubt. It is normal to enter an adjustment process through which a final sense of peace can be achieved. Granting yourself the grief you may feel and being fully aware of it is hard but it is a useful process. Below are descriptions of the stages you may encounter as you learn to accept your child s diagnosis of hearing loss. You may find that you move from one stage to a new one and back again. Remember, it takes time to understand and accept the fact that your child has a hearing loss. As soon as you are able to do this, you can begin to focus on how to cope with it. Denial Denial means to dismiss what in fact has happened. It can provide a useful function. It can allow time to work through the early shock. It can also be harmful. It might cause delay in follow up or action needed for your infant or child. Anger You have a right to feel angry. You may wonder Why my baby or child? Your anger may be aimed at the experts who were involved in finding the hearing loss. It can also become a factor in your talking and dealing with other family members and experts. Fear/Anxiety Fear of the unknown is normal. Many unknowns about your child s hearing loss may make you fearful. What will the future be like? Will my child learn to talk? Will my child go to college? Will the hearing loss get worse?

3 Guilt You may have some feelings of guilt. What caused my child s hearing loss? Is it something I did or did not do that has caused my child s hearing loss? Feeling guilty implies you have the power to make things happen or to prevent things from happening. Keep in mind, there are many things in life over which you have no control. Acceptance Once you have a better understanding of hearing loss and become acquainted with other parents of children with hearing loss, you will learn that your child can have a normal, fulfilling life. It will become clear that your child can have a good future as a productive adult regardless of the communication mode that is chosen, or how severe your child s hearing loss is. Hope After you have accepted your child s hearing loss the hope that you feel for his or her future will become the driving force that provides you the means to make a plan of action to help your child succeed. Remember you are not alone. Don t be afraid to seek help and support. We have listed several local and national support organizations in the resources section of this booklet. Adapted from Oticon s Workbook for Parents of Children Who are Newly Identified as Hard of Hearing

4 DEGREE OF LONG-TERM HEARING LOSS TO PSYCHOSOCIAL IMPACT AND EDUCATIONAL NEEDS Degree of Hearing Loss Based on modified pure tone average ( HZ) Possible Effect of Hearing Loss on the Understanding of Language & Speech Possible Psychological Impact of Hearing Loss Potential Educational Needs and Programs NORMAL HEARING db HL Children have better hearing sensitivity than the accepted normal range for adults. A child with hearing sensitivity in the - 10 to +15 db range will detect the complete speech signal even at soft conversation levels. However, good hearing does not guarantee good ability to discriminate speech in the presence of background noise. MINIMAL (BORDERLINE) db HL MILD db HL May have difficulty hearing faint or distant speech. At 15 db student can miss up to 10% of speech signal when teacher is at a distance greater than 3 feet and when the classroom is noisy, especially in the elementary grades when verbal instruction predominates At 30 db can miss 25-40% of speech signal. The degree of difficulty experienced in school will depend upon the noise level in classroom, distance from teacher and the configuration of the hearing loss. Without amplification the child with db loss may miss at least 50% of class discussions, especially when voices are faint or speaker is not in line of vision. Will miss consonants, especially when a high frequency hearing loss is present. May be unaware of subtle conversation cues which could cause child to be viewed as inappropriate or awkward. May miss portions of fast-paced peer interactions which could begin to have an impact on socialization and self concept. May have immature behavior. Child may be more fatigued than classmates due to listening effort needed. Barriers beginning to build with negative impact on self esteem as child is accused of "hearing when he or she wants to", "daydreaming", or "not paying attention". Child begins to lose ability for selective heari ng, and has increasing difficulty suppressing background noise which makes the learning environment stressful. Child is more fatigued than classmates due to listening effort needed. May benefit from mild gain/low MPO hearing aid or personal FM system dependent on loss configuration. Would benefit from soundfield amplification if classroom is noisy and/or reverberant. Favorable seating. May need attention to vocabulary or speech, especially with recurrent otitis media history. Appropriate medical management necessary for conductive losses. Teacher requires inservice on impact of hearing loss on language development and learning. Will benefit from a hearing aid and use of a personal FM or soundfield FM system in the classroom. Needs favorable seating and lighting. Refer to special education for language evaluation and educational follow-up. Needs auditory skill building. May need attention to vocabulary and language development, articulation or speech reading and/or special support in reading. May need help with self esteem. Teacher inservice required.

5 DEGREE OF LONG-TERM HEARING LOSS TO PSYCHOSOCIAL IMPACT AND EDUCATIONAL NEEDS MODERATE db HL MODERATE TO SEVERE db HL Understands conversational speech at a distance of 3-5 feet (faceto-face) only if structure and vocabulary controlled. Without amplification the amount of speech signal missed can be 50% to 75% with 40 db loss and 80% to 100% with 50 db loss. Is likely to have delayed or defective syntax, limited vocabulary, imperfect speech production and an atonal voice quality. Without amplification, conversation must be very loud to be understood. A 55 db loss can cause child to miss up to 100% of speech information. Will have marked difficulty in school situations requiring verbal communication in both one-to-one and group situations. Delayed language, syntax, reduced speech intelligibility and atonal voice quality likely. Ofte n with this degree of hearing loss, communication is significantly affected, and socialization with peers with normal hearing becomes increasingly difficult. With full time use of hearing aids/fm systems child may be judged as a less competent learner. There is an increasing impact on self-esteem. Full time use of hearing aids/fm systems may result in child being judged by both peers and adults as a less competent learner, resulting in poorer self concept, social maturity and contributing to a sense of rejection. Inservice to address these attitudes may be helpful. Refer to special education for language evaluation and for educational followup. Amplification is essential (hearing aids and FM system). special education support may be needed, especially for primary child ren. Attention to oral language development, reading and written language. Auditory skill development and speech therapy usually needed. Teacher inservice required. Full time use of amplification is essential. Will need resource teacher or special class depending on magnitude of language delay. May require special help in all language skills, language based academic subjects, vocabulary, grammar, pragmatics as well as reading and writing. Probably needs assistance to expand experimental language base. Inservice of mainstream teachers required. SEVERE db HL Without amplification may hear loud voices about one foot from ear. When amplified optimally, children with hearing ability of 90 db or better should be able to identify environmental sounds and detect all of the sounds of speech. If loss is of prelingual onset, oral language and speech may not develop spontaneously or will be severely delayed. If hearing loss is of recent onset speech is likely to deteriorate with quality becoming atonal. Child may prefer other children with hearing impairments as friends or playmates. This may further isolate the child from the mainstream, however, these peer relationships may foster improved self concept and a sense of cultural identity. May need full-time special aural/oral program for with emphasis on all auditory language skills, speechreading, concept development and speech. As loss approaches 80-90dB, may benefit from a Total Communication approach, especially in the early language learning years. Individual hearing aid/personal FM system essential. Need to monitor effectiveness of communication modality. Participation in regular classes as much as beneficial to student. Inservice of mainstream teachers essential. PROFOUND 91 db HL or more Aware of vibrations more than tonal pattern. Many rely on vision rather than hearing as primary avenue for communication and learning. Detection of speech sounds dependent upon loss configuration and use of amplification. Speech and language will not develop spontaneously and is likely to deteriorate rapidly if hearing loss is of recent onset. Depending on auditory/oral competence, peer use of sign language, parental attitude, etc., child may or may not increasingly prefer association with the deaf culture. May need special program for deaf children with emphasis on all language skills and academic areas. Program needs specialized supervision and comprehensive support services. Early use of amplification likely to help if part of an intensive training program. May be cochlear implant or vibrotactile aid candidate.

6 DEGREE OF LONG-TERM HEARING LOSS TO PSYCHOSOCIAL IMPACT AND EDUCATIONAL NEEDS requires continual appraisal of needs in regard to communication and learning mode. Parttime in regular classes as much as beneficial to student. UNILATERAL One normal hearing ear and one ear with at least a permanent mild hearing loss May have difficulty hearing faint or distant speech. Usually has difficulty localizing sounds and voices. Unilateral listener will have greater difficulty understanding speech when environment is noisy and/or reverberant. Difficulty detecting or understanding soft speech from side of bad ear, especially in group discussion. Child may be accused of selective hearing due to discrepancies in speech understanding in quiet versus noise. Child will be more fatigued in classroom setting due to greater effort needed to listen. May appear inattentive or frustrated. Behavior problems sometimes evident. May benefit from personal FM or soundfield FM system in classroom. CROS hearing aid may be of benefit in quiet settings. Needs favorable seating and lighting. Student is at risk for educational difficulties. Educational monitoring warranted with support services provided as soon as difficulties appear. Teacher inservice is beneficial. NOTE: All children with hearing loss require periodic audiologic evaluation, rigorous monitoring of amplification and regular monitoring of communication skills. All children with hearing loss (especially conductive) need appropriate medical attention in conjunction with educational programming. References: Olsen, W.O., Hawkins, D.B. VanTassell, D.J. (1987). Representatives of the Longterm Spectrum of Speech. Ear & Hearing, Supplement 8, pp Mueller, H.G. & Killion, M.C. (1990). An easy method for ca lculating the articulation index. The Hearing Journal 43, 9, pp Hasenstab, M. S. (1987). Language Learning and Otitis Media, College Hill Press, Boston, MA. Developed by: Karen L. Anderson, Ed.S & Noel D. Matkin, Ph.D (1991) Adapted from: Bernero, R.J. & Bothwell, H. (1966). Relationship of Hearing Impairment to Eductional Needs. Illinois Department of Public Health & Office of Superintendent of Public Instruction. Peer Review by: Members of the Eductional Audiology Association, Winter 1991.

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